First name
Paul
Middle name
A
Last name
Offit

Title

COVID-19 Vaccine Hesitancy among Physicians, Physician Assistants, Nurse Practitioners, and Nurses in Two Academic Hospitals in Philadelphia.

Year of Publication

2021

Number of Pages

1-24

Date Published

2021 Sep 20

ISSN Number

1559-6834

Abstract

<p><strong>OBJECTIVE: </strong>To evaluate COVID-19 vaccine hesitancy among health care personnel (HCP) with significant clinical exposure to COVID-19 at two large, academic hospitals in Philadelphia.</p>

<p><strong>DESIGN, SETTING AND PARTICIPANTS: </strong>HCP were surveyed between November-December 2020 about their intention to receive the COVID-19 vaccine.</p>

<p><strong>METHODS: </strong>The survey measured the intent among HCP to receive a COVID-19 vaccine, timing of vaccination, and reasons for or against vaccination. Among patient-facing HCP, multivariate regression evaluated the associations between healthcare positions (MD, NP/PA, RN) and vaccine hesitancy (intending to decline, delay, or were unsure about vaccination), adjusting for demographic characteristics, reasons why or why not to receive the vaccine, and prior receipt of routine vaccines.</p>

<p><strong>RESULTS: </strong>Among 5,929 HCP (2,253 MDs/DOs, 582 NPs, 158 PAs, and 2,936 nurses), a higher proportion of nurses (47.3%) were COVID-vaccine hesitant compared with 30.0% of PAs/NPs and 13.1% of MDs/DOs. The most common reasons for vaccine hesitancy included concerns about side effects, the newness of the vaccines, and lack of vaccine knowledge. Regardless of position, Black HCP were more hesitant than White HCP (OR∼5) and females were more hesitant than males (OR∼2).</p>

<p><strong>CONCLUSION: </strong>Although a majority of clinical HCP intended to receive a COVID-19 vaccine, intention varied by healthcare position. Consistent with other studies, hesitancy was also significantly associated with race/ethnicity across all positions. These results underline the importance of understanding and effectively addressing reasons for hesitancy, especially among frontline HCP who are at increased risk of COVID exposure and play a critical role in recommending vaccines to patients.</p>

DOI

10.1017/ice.2021.410

Alternate Title

Infect Control Hosp Epidemiol

PMID

34538290
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Racial/Ethnic Differences in COVID-19 Vaccine Hesitancy Among Health Care Workers in 2 Large Academic Hospitals.

Year of Publication

2021

Number of Pages

e2121931

Date Published

2021 Aug 02

ISSN Number

2574-3805

Abstract

<p><strong>Importance: </strong>Significant differences in hesitancy to receive COVID-19 vaccination by race/ethnicity have been observed in several settings. Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers (HCWs), who face occupational and community exposure to COVID-19, have not been well described.</p>

<p><strong>Objective: </strong>To assess hesitancy to COVID-19 vaccination among HCWs across different racial/ethnic groups and assess factors associated with vaccine hesitancy.</p>

<p><strong>Design, Setting, and Participants: </strong>This survey study was conducted among HCWs from 2 large academic hospitals (ie, a children's hospital and an adult hospital) over a 3-week period in November and December 2020. Eligible participants were HCWs with and without direct patient contact. A 3-step hierarchical multivariable logistic regression was used to evaluate associations between race/ethnicity and vaccine hesitancy controlling for demographic characteristics, employment characteristics, COVID-19 exposure risk, and being up to date with routine vaccinations. Data were analyzed from February through March 2021.</p>

<p><strong>Main Outcomes and Measures: </strong>Vaccine hesitancy, defined as not planning on, being unsure about, or planning to delay vaccination, served as the outcome.</p>

<p><strong>Results: </strong>Among 34 865 HCWs eligible for this study, 12 034 individuals (34.5%) completed the survey and 10 871 individuals (32.2%) completed the survey and reported their race/ethnicity. Among 10 866 of these HCWs with data on sex, 8362 individuals (76.9%) were women, and among 10 833 HCWs with age data, 5923 individuals (54.5%) were younger than age 40 years. (Percentages for demographic and clinical characteristics are among the number of respondents for each type of question.) There were 8388 White individuals (77.2%), 882 Black individuals (8.1%), 845 Asian individuals (7.8%), and 449 individuals with other or mixed race/ethnicity (4.1%), and there were 307 Hispanic or Latino individuals (2.8%). Vaccine hesitancy was highest among Black HCWs (732 individuals [83.0%]) and Hispanic or Latino HCWs (195 individuals [63.5%]) (P &lt; .001). Among 5440 HCWs with vaccine hesitancy, reasons given for hesitancy included concerns about side effects (4737 individuals [87.1%]), newness of the vaccine (4306 individuals [79.2%]), and lack of vaccine knowledge (4091 individuals [75.2%]). The adjusted odds ratio (aOR) for vaccine hesitancy was 4.98 (95% CI, 4.11-6.03) among Black HCWs, 2.10 (95% CI, 1.63-2.70) among Hispanic or Latino HCWs, 1.48 (95% CI, 1.21-1.82) among HCWs with other or mixed race/ethnicity, and 1.47 (95% CI, 1.26-1.71) among Asian HCWs compared with White HCWs (P &lt; .001). The aOR was decreased among Black HCWs when adjusting for employment characteristics and COVID-19 exposure risk (aOR, 4.87; 95% CI, 3.96-6.00; P &lt; .001) and being up to date with prior vaccines (aOR, 4.48; 95% CI, 3.62-5.53; P &lt; .001) but not among HCWs with other racial/ethnic backgrounds.</p>

<p><strong>Conclusions and Relevance: </strong>This study found that vaccine hesitancy before the authorization of the COVID-19 vaccine was increased among Black, Hispanic or Latino, and Asian HCWs compared with White HCWs. These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed.</p>

DOI

10.1001/jamanetworkopen.2021.21931

Alternate Title

JAMA Netw Open

PMID

34459907
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Perspectives on the receipt of a COVID-19 vaccine: A survey of employees in two large hospitals in Philadelphia.

Year of Publication

2021

Number of Pages

Date Published

2021 Feb 16

ISSN Number

1873-2518

Abstract

<p><strong>BACKGROUND: </strong>Health care personnel have been identified by the ACIP as a priority group for COVID-19 vaccination. We conducted a survey in November-December 2020 at two large, academic hospitals in Philadelphia to evaluate the intention of hospital employees to be vaccinated.</p>

<p><strong>METHODS: </strong>The survey was sent electronically to all employees (clinical and nonclinical staff) at a children's hospital and an adult hospital. The survey was voluntary and confidential. Questions focused on plans to receive a COVID-19 vaccine when available, reasons why employees would/would not get vaccinated, when employees planned to be vaccinated, vaccine safety and efficacy features that would be acceptable, and past history of receipt of other vaccines by the employee and family. Responses were analyzed using univariate and multiple logistic regression methods.</p>

<p><strong>RESULTS: </strong>A total of 12,034 hospital employees completed the survey (a 34.5% response rate). Overall, 63.7% of employees reported that they planned to receive a COVID-19 vaccine, 26.3% were unsure, and 10.0% did not plan to be vaccinated. Over 80% of those unsure or unwilling to be vaccinated expressed concerns about vaccine side effects and the vaccines' newness. In multivariable logistic regression, persons planning to take a COVID-19 vaccine were more likely to be older, male, more educated, Asian or White, up-to-date on vaccinations, without direct patient contact, and tested for COVID-19 in the past. No significant difference in intention to be vaccinated was found between those with higher versus lower levels of exposure to COVID-19 patients or the number of previous exposures to patients with COVID-19.</p>

<p><strong>CONCLUSIONS: </strong>While the majority of hospital employees are planning to receive a COVID-19 vaccine, many are unsure or not planning to do so. Further education of hospital employees about the safety, efficacy, and value of the currently available COVID-19 vaccines is critical to vaccine acceptance in this population.</p>

DOI

10.1016/j.vaccine.2021.02.029

Alternate Title

Vaccine

PMID

33632563
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Implementation of a Mandatory Influenza Vaccine Policy: A 10-Year Experience.

Year of Publication

2020

Number of Pages

Date Published

2020 Jun 17

ISSN Number

1537-6591

Abstract

<p><strong>BACKGROUND: </strong>Influenza vaccination of healthcare workers (HCWs) has been recommended for more than 30 years. In 2009, HCWs were designated as a priority group by the Centers for Disease Control and Prevention. Current HCW vaccination rates are 78% across all settings and reach approximately 92% among those employed in hospital settings. Over the last decade, it has become clear that mandatory vaccine policies result in maximal rates of HCW immunization.</p>

<p><strong>METHODS: </strong>In this observational 10-year study, we describe the implementation of a mandatory influenza vaccination policy in a dedicated quaternary pediatric hospital setting by a multidisciplinary team. We analyzed 10 years of available data from deidentified occupational health records from 2009-2010 through the 2018-2019 influenza seasons. Descriptive statistics were performed using Stata v15 and Excel.</p>

<p><strong>RESULTS: </strong>Sustained increases in HCW immunization rates above 99% were observed in the 10 years postimplementation, in addition to a reduction in exemption requests and healthcare-associated influenza. In the year of implementation, 145 (1.6%) HCWs were placed on temporary suspension for failure to receive the vaccine without documentation of an exemption, with 9 (0.06%) subsequently being terminated. Since then, between 0 and 3 HCWs are terminated yearly for failure to receive the vaccine.</p>

<p><strong>CONCLUSIONS: </strong>Implementation of our mandatory influenza vaccination program succeeded in successfully increasing the proportion of immunized HCWs at a quaternary care children's hospital, reducing annual exemption requests with a small number of terminations secondary to vaccine refusal. Temporal trends suggest a positive impact on the safety of our patients.</p>

DOI

10.1093/cid/ciaa782

Alternate Title

Clin Infect Dis

PMID

33372217
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Comparison of immunization systems in Japan and the United States - What can be learned?

Year of Publication

2020

Number of Pages

Date Published

2020 Sep 28

ISSN Number

1873-2518

Abstract

<p>Recently, efforts have been made to fill a so-called "vaccine gap" between Japan and other countries; however, more work remains. Concerns about adverse events following immunization (AEFI) resulted in an historically passive approach to policy making in the National Immunization Program (NIP). For example, reports of AEFI following human papillomavirus vaccine (HPVV) in 2013 led the Japanese government to withdraw its proactive recommendations, resulting in a sharp drop in HPVV coverage rate to less than 1.0%. In this report, we review key historical incidents that led to the current immunization system in Japan, compare it to that in the United States, and discuss strategies for improving the Japanese immunization system. By strengthening existing policies and programs, such as National Immunization Technical Advisory Groups and AEFI reporting, compensation laws, and immunization education, the remaining vaccine gap in Japan could be filled.</p>

DOI

10.1016/j.vaccine.2020.09.028

Alternate Title

PMID

33004240
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Japanese physicians' attitudes and intentions regarding human papillomavirus vaccine compared with other adolescent vaccines.

Year of Publication

2019

Number of Pages

193-200

Date Published

2019 06

ISSN Number

2405-8521

Abstract

<p><strong>INTRODUCTION: </strong>Japan has experienced extremely low human papillomavirus vaccine (HPVV) coverage following the suspension of proactive governmental recommendations in 2013. Several studies have reported that recommendations from physicians increase adolescents' vaccine acceptance. In this survey, we evaluated the attitudes and intentions of Japanese physicians related to adolescent immunizations, particularly HPVV.</p>

<p><strong>METHODS: </strong>We conducted a cross-sectional study using a mailed questionnaire targeting 330 Japanese physicians including 78 pediatricians, 225 internists and 27 obstetricians and gynecologists (OB/GYNs) in Kawasaki City, Japan in 2016. The survey measured physicians' reported frequency of educating adolescents about vaccines as well as their own perceptions and intentions related to adolescent immunizations.</p>

<p><strong>RESULTS: </strong>Valid responses were obtained from 148 (45%) physicians. Though 53% agreed that the HPVV should be recommended, only 21% reported educating about HPVV. The majority of respondents (90%) agreed that they would restart HPVV for adolescents if the government reinstated its recommendation.</p>

<p><strong>CONCLUSIONS: </strong>Although Japanese physicians reported support for adolescent immunizations, they were less likely to recommend or discuss HPVV compared with other adolescent vaccines. Responses indicated this was, at least in part, due to the lack of governmental support for HPVV, indicating that their recommendations would improve with government endorsement of the vaccine.</p>

DOI

10.1016/j.pvr.2019.04.013

Alternate Title

Papillomavirus Res

PMID

31051270
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Treatment With Quadrivalent Human Papillomavirus Vaccine for Juvenile-Onset Recurrent Respiratory Papillomatosis: Case Report and Review of the Literature.

Year of Publication

2017

Number of Pages

Date Published

2017 Aug 08

ISSN Number

2048-7207

Abstract

<p>Although juvenile-onset recurrent respiratory papillomatosis (JoRRP) generally involves a benign tumor on the larynx and other respiratory tract areas, almost all patients with this disease require repeated surgical intervention (to prevent airway obstruction during the course of illness) and various adjuvant therapies such as interferon, cidofovir, acyclovir, ribavirin, indole-3-carbinol, HspE7, mumps vaccine, photodynamic therapy, propranolol, cimetidine, and bevacizumab. Some case reports recently described the effectiveness of the quadrivalent human papillomavirus vaccine (HPV4) as an adjuvant therapy. On the basis of these reports, we administered HPV4 to a 2-year-old boy with JoRRP. However, no therapeutic effect was found. A review of the available literature revealed that current evidence for the effectiveness of therapeutic HPV4 and other adjuvant therapies for JoRRP is inconsistent. Therefore, the prophylactic use of currently available HPV vaccine for adolescents is the most effective strategy for preventing not only anogenital cancers but also genital warts, which might be a risk factor for JoRRP among their children in the future.</p>

DOI

10.1093/jpids/pix063

Alternate Title

J Pediatric Infect Dis Soc

PMID

28992265
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

The impact of access to immunization information on vaccine acceptance in three countries.

Year of Publication

2017

Number of Pages

e0180759

Date Published

2017

ISSN Number

1932-6203

Abstract

<p><strong>INTRODUCTION: </strong>Vaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.</p>

<p><strong>OBJECTIVE: </strong>The objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.</p>

<p><strong>METHODS: </strong>We conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.</p>

<p><strong>RESULTS: </strong>Dominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.</p>

<p><strong>CONCLUSIONS: </strong>In Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.</p>

DOI

10.1371/journal.pone.0180759

Alternate Title

PLoS ONE

PMID

28771485
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

"Compassionate use" for public health.

Year of Publication

2014

Number of Pages

421-2

Date Published

03/2014

ISSN Number

1539-3704

DOI

10.7326/M13-2927

Alternate Title

Ann. Intern. Med.

PMID

24366602
Inner Banner
Publication Image
Inner Banner
Publication Image

Title

Delaying vaccination is not a safer choice.

Year of Publication

2013

Number of Pages

1097-8

Date Published

2013 Dec

ISSN Number

2168-6211

DOI

10.1001/jamapediatrics.2013.3071

Alternate Title

JAMA Pediatr

PMID

24126848
Inner Banner
Publication Image
Inner Banner
Publication Image